Frequently nebulized β-agonists for asthma: Effects on serum eleetrolytes

Bodenhamer, James; Bergstrom, Roy; Brown, D. C.; Gabow, Patricia A.; Marx, John A.; Lowenstein, Steven R.

doi:10.1016/s0196-0644(05)81898-0

Cited by 59 publications

(22 citation statements)

References 29 publications

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“…Our data suggest that hypophosphatemia is a consequence of GTC seizures rather than the cause, and the spontaneous tendency to normalize within a few hours suggests a redistribution mechanism over loss through renal excretion . It is known that stress hormones such as epinephrine or glucagon lead to electrolyte redistribution and particularly considerable intracellular phosphate shifts . Intense physical effort has also been found to cause parathormone variations, which lead to transient hypophosphatemia .…”

Section: Discussionmentioning

confidence: 60%

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

et al. 2019

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Objective Transient loss of consciousness (TLOC) is a common presentation in the emergency room, where patient history can usually differentiate syncope from generalized tonic‐clonic (GTC) seizures. Several serum markers, such as creatine kinase and lactate, can be helpful, especially when history is unreliable. Here, we explore a potential supporting role of electrolyte plasma levels in a case‐control study. Methods In our electroencephalographic database, we retrospectively identified consecutive episodes of loss of consciousness in adults seen over 3 years in our hospital emergency department for a case‐control study. We investigated plasma levels of several electrolytes (sodium, potassium, phosphate, calcium, magnesium) at the emergency visit, as well as demographics, diagnosis, blood‐sample delay time, and history of alcohol abuse. Results Of the 126 patients identified, 75 had GTC seizures and 46 had other TLOC causes. Among electrolyte levels, only hypophosphatemia was associated with GTC seizures (median = 0.79 mmol·L–1, range = 0.34‐1.37 in GTC seizures vs 0.93 mmol·L–1, range = 0.52‐1.56, P = 0.001 in TLOC). After adjusting for blood sampling delay, alcohol abuse, and other electrolyte levels, only hypophosphatemia was associated with GTC seizures, occurring in 37 (51%) of GTC seizures and 12 (22%) of other TLOC (odds ratio = 3.5, 95% confidence interval = 1.5‐8.3, P = 0.003). Hypophosphatemia < 0.6 mmol·L–1 was 93% specific and 20% sensitive for GTC seizure occurrence. In follow‐ups, hypophosphatemia was transitory. Significance Transient hypophosphatemia is common after GTC seizures and could represent an additional biological marker to help differentiate GTC seizures from other TLOC, especially when history is unclear. This hypothesis needs to be tested prospectively.

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Section: Discussionmentioning

confidence: 60%

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

et al. 2019

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“…In the current study patients had decreased serum levels of magnesium than controls. This could be explained by hypomagnesemia caused by repeated use of β 2 -agonist inhalation or nebulisation [18, 19] in turn causing vitamin D deficiency [20]. …”

Section: Discussionmentioning

confidence: 99%

Serum Magnesium and Vitamin D Levels as Indicators of Asthma Severity

et al. 2016

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Background. Serum magnesium levels affect the concentration of circulating vitamin D in blood and subsequently it affects the immunity; thus it plays significant role in the pathogenesis of asthma. Asthma, in adults, is less studied and hypomagnesemia along with vitamin D deficiency and insufficiency is common in asthmatic individuals, which causes frequent asthma attacks, respiratory infections, severe exacerbations, and poor response to bronchodilators. Objective. To detect the magnitude of vitamin D insufficiency and deficiency and serum magnesium levels among asthmatic patients and to correlate them with the severity of asthma. Materials and Methods. This is a cross-sectional case-control study which includes 60 patients of chronic stable asthma and 60 healthy controls. After taking clinical history and systemic examination, pulmonary function test was done. Serum levels of magnesium, 25-hydroxycholecalciferol [25(OH)D], and calcium were measured in all the subjects. Results. Significant correlation was found between vitamin D deficiency, hypomagnesemia, and asthma severity. Serum calcium levels were unaffected by that. Conclusion. Vitamin D and serum magnesium deficiency are highly prevalent in patients with asthma. Increased asthma severity, frequency of attacks, and exacerbation are associated with lower levels of one or both. Serum 25(OH)D and magnesium levels may serve as important markers of asthma severity.

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“…The variable reported results in relation to magnesium and potassium could be related to the opposing e ects of a and b adrenoreceptors, 18 ± 20 the former of which appear to inhibit cellular uptake whilst the latter promote it, as during b agonist therapy for acute asthma. 21 Though falls in both magnesium and potassium were documented in the latter study unfortunately no blood gas changes were reported, for an improvement in pH in response to treatment might in itself have shifted potassium. The patient under anaesthesia, when the sympathetic system is at least partly suppressed, probably resembles the tetraplegic more closely than the hyperventilating volunteer, and so one would anticipate that the direction of change of these electrolytes in spinal cord damage would also be to fall with a rise in pH.…”

Section: Acid-base and Electrolytesmentioning

confidence: 76%

Respiratory alkalosis and associated electrolytes in long-term ventilator dependent persons with tetraplegia

Watt¹,

Silva

2001

Spinal Cord

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Study design: A pilot case control study of the acid-base and electrolyte status in 30 longterm ventilator-dependent (LTVD) and 30 self ventilating persons with tetraplegia. Objectives: To assess the extent of respiratory alkalosis and screen for associated hypokalaemia, hypomagnesaemia and/or hypophosphataemia. Setting: Medically stable persons with tetraplegia under the long-term care of the Southport Spinal Injuries Centre, England. Methods: Blood gases and electrolytes were sampled from 30 control patients with tetraplegia and from 30 patients having been LTVD for more than 12 months. Results: All the blood gas measurements in the LTVD group lay outside both the reference range and the 95% con®dence intervals (CI) of the control group: pH 7.46 (0.06); PCO 2 3.46 (1.1) kPa; bicarbonate 18.3 (3.8) and base excess 73.2 (2.8) mmol/l; PO 2 13.8 (2.8) kPa (means and standard deviations). The serum potassium, magnesium, phosphate, and sodium means lay within the reference ranges but the potassium, phosphate and calcium were at or below the 95% CI of the control values. One patient on part-time ventilatory support having less bicarbonate compensation had low serum electrolytes during ventilation. Conclusion: There was no evidence of biochemical jeopardy from long-term mechanical hyperventilation although acutely administered hyperventilation has the potential to cause falls in serum potassium, magnesium and phosphate and so caution should be exercised in part-time ventilated persons. The full range of electrolytes should be assayed during stabilisation in LTVD and periodically thereafter. Hyperventilation helps to maintain good oxygenation in LTVD persons with paralysis and normal lungs. Sponsorship: None.

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Frequently nebulized β-agonists for asthma: Effects on serum eleetrolytes

Cited by 59 publications

References 29 publications

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

Serum Magnesium and Vitamin D Levels as Indicators of Asthma Severity

Respiratory alkalosis and associated electrolytes in long-term ventilator dependent persons with tetraplegia

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